Zimbabwe: UNICEF Zimbabwe is inviting proposals from Individual national or international consultants for the Provision of Technical Support in IMNCI, ETAT & IMAM training assessment

Organization: UN Children’s Fund
Country: Zimbabwe
Closing date: 05 Apr 2018

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IMNCI – Integrated Management of Newborn and Childhood Illness

In the mid-1990s, Integrated Management of Childhood Illness (IMCI) was developed by WHO and UNICEF in efforts to reduce under five child mortality and morbidity from common childhood Illnesses and to promote healthy child growth and development for children under five in countries with high child mortality rates (>40 per 1000 live births). Later, the care for newborns was added and the strategy was renamed as IMNCI. There are three main components to the IMNCI strategy: 1) improving health worker skills, 2) strengthening health systems and 3) improving family and community practices.

In 2000, Zimbabwe adopted the IMNCI strategy, managing in an integrated manner the six major diseases that cause 70% of all under five deaths in the country (pneumonia, malaria, measles, malnutrition, diarrhea and HIV/AIDS). The Ministry of Health and Child Care (MoHCC) set ambitious targets that at least 2 health workers at every health facility be trained in IMNCI. To date, the MOHCC has achieved 87.6% of health facilities with at least 1 IMNCI trained health worker and 49.8% of health facilities with at least 2 IMNCI trained health workers. The global recommendation is to have at least 60% of health workers providing care for sick children being trained in IMNCI.

Despite high coverage of IMNCI trained staff, the last 2 decades have witnessed the emergence of specific child health programmes and interventions which to some extent have weakened the overall approach of a holistic view of child health and ensuring a continuum of care. At the same time, in Zimbabwe the IMNCI strategy has undergone many changes with respect to its training and implementation modalities. At present, the training module has been reduced to 6 days with a focus on case management and a distance learning module has also been introduced. Prior to additional investments in the efforts to expand the strategy’s implementation, it is considered important to conduct an assessment to determine the effectiveness of the current model of IMNCI training, a blended case management approach and distance learning, in delivering the right skills and level of application of skills by trained health workers.

IMAM – Integrated Management of Acute Malnutrition

The Integrated Management of Acute Malnutrition (IMAM) program key outcome indicators of cure and defaulter rates in Zimbabwe have not met sphere targets over the last three years. This is despite various emergency response programs funded by donors over the period 2015 to 2017. In total, 42 out of 63 districts have received IMAM trainings using updated Outpatient Therapeutic Program (OTP) guidelines since 2015. Yet cure rate, though on the upward trend, has remained off target. Defaulter rates have been marginally off target and generally very high in some specific areas. As of January 2018; The overall cure rate was 67%, which is slightly off the sphere target of >=75%. The average defaulter rate was 16.1%, which is slightly above the global threshold of 15%. Preliminary observations through routine supportive supervision also indicated that there were challenges of poor documentation (including under reporting) and misclassification of outcomes. Gaps and discrepancies were also observed in data capturing; with DHIS2 and active screening records not matching. There are thus major issues with quality assurance of the nutrition program. Assessing the capacity building methods and extent of adherence to OTP guidelines in IMAM program implementation by all relevant parties will hopefully give an insight on how to best improve quality of IMAM service delivery.

ETAT – Emergency Triage and Treatment

WHO developed guidelines for Emergency Triage and Treatment in 2005, and these were shown to improve quality of emergency care and reduced early mortality in hospitals in Africa. Zimbabwe adopted the ETAT approach training in 2015. ETAT targets health workers who offer emergency care of sick children in hospitals (pediatricians, general medical officers, pediatric nurses and nurses working in pediatric outpatients). Training materials were adapted and adopted from the WHO ETAT course and the Kenyan ETAT plus admission care of newborns and children within the first 48 hours, in collaboration with the Paediatric Association of Zimbabwe. To date ETAT training workshops have been conducted in the Central Hospitals (Parirenyatwa, HCH, Chitungwiza and Mpilo) and in six of the rural provinces. While ETAT is seen as an important course, resources have been decreasing to support this training course.

In summary, the three above mentioned trainings are at different stages of implementation and yet similar issues around skill application are evident. The current assessment aims to provide data that the training approaches of these 3 interventions is optimal and in fact yield desired results in manner that is cost effective.


Assess the effectiveness of the current model of IMNCI, ETAT and IMAM training in delivering the right skills and level of application of skills by trained health workers


It is anticipated that the assessment will:

  • At output level, lead to recommendations for improved training methodologies as well as more conducive environments for skill application.
  • At outcome level, guide further expansion of IMNCI, ETAT and IMAM programming resulting in improved management of human resources as well as cost savings by way of promoting integration opportunities and ultimately more effective use of programme budgets, especially for training and monitoring purposes.
  • At impact level, lead to improved quality of care and the reduction in preventable newborn and child deaths.
  • Objectives & Justification

    The principal objective of this assignment is two-fold:

  • Assess the effectiveness of the current models of IMNCI, ETAT and IMAM training in delivering the right skills
  • Assess the level of skill application by trained health workers, including analysis of health worker turnover, attrition of skills, supervision & monitoring, and other environmental factors challenging skill uptake
  • Crosscutting research questions

  • Who are the trainers and who are the participants?
  • Are the people who are trained applying their skills? What are the bottlenecks hampering the application of skills by health workers? What are the bottlenecks in monitoring application of the skills by health workers and what are the opportunities to improve those?
  • What are the opportunities for accelerating the expansion of ETAT, IMNCI and IMAM trainings (extension to private sector, inclusion in pre-service curricula) and the resource implications?
  • What are the opportunities for integration, harmonization and synergies across the different programmes

    Specific research questions for IMNCI are:

  • What are the implications of having reduced IMNCI training from 14 days to 6; classroom versus distance and blended learning?
  • Are international standards are being upheld?
  • What are the training costs for all training approaches and value for money?
  • How useful, applicable and effective are the tools used in for the distance learning module?
  • Specific research questions for IMAM are:

  • What are the key drivers of high defaulter and non-recovered rates among SAM children? To
  • what extent do health workers adhere to the existing IMAM guidelines and standard case

    definitions for classification and reporting treatment outcomes?

  • To what extent do the existing pre-service nursing curriculum adequate in effective delivery of IMAM services? Is the existing IMAM training package and implementation protocol effective in improving quality of IMAM service delivery?
  • What is the cost of treating severe acute malnutrition in Zimbabwe? What can be done differently, cost-effectively and still achieve expected program performance?
  • Specific research questions for ETAT are:

  • What has been the scope and reach of ETAT training and its implementation thus far?
  • Who are the trainers and who are the participants?
  • Are there any differences/variations in ETAT implementation modalities across the different regions? What are the reasons for differences?
  • Did ETAT effect changes in practice among participants? What factors contributed to positive/negative changes?
  • Methodology

    The consultant/multi-disciplinary team will work closely with the Ministry of Health and Child Care’s Child Survival Technical Working Group, which will orient, guide and validate the assessment.

  • The assessment is intended to be both quantitative and qualitative in nature, covering a representative sample of district health facilities throughout the country. The training methodologies employed for IMNCI, ETAT and IMAM are to be examined, including the pilot implementation of the distance IMNCI “Computerized Adaptation and Training Tool”.
  • The consultant/group of consultants will be required to validate the chosen assessment methodology with the MoHCC, WHO and UNICEF, and likewise prepare a detailed assessment implementation plan which will be regularly monitored.
  • Expected Outputs/deliverable

  • Inception report
  • Presentation of key findings and recommendations to principal stakeholders
  • Assessment report covering IMNCI, ETAT and IMAM including recommendations for improving training effectiveness, skill application; on-site monitoring mechanisms; revised programme indicators. Report is to include any additional recommendations coming from the restitution to stakeholders
  • Major tasks and Deliverables


    Major Tasks



    Desk review of key national child health strategies and protocols, health information system data trends, training reports and other relevant resources/references

    Inception report and Situational analysis report


    Hold discussions with key stakeholders at national, provincial and district levels

    Stakeholder consultations reports


    Develop/design assessment concept, plan and collection and analysis tools

    Concept note and data analysis tools


    Implementation of assessment in the field

    Field work report


    Data analysis and presentation of findings

    Presentation of findings


    Assessment write up & restitution of results to stakeholders

    Final assessment report

    Consultancy Timeframe

    The consultant is expected to work for a total of thirty (30) days over a period of two (2) months. While the period for the development of the NCBHS document has been defined, the specific timelines for the development of the various components will be developed by the TWG considering the advice of the consultant. Based on the agreement, the consultant will develop his/her workplan indicating the different types of support to be provided at different stages.

    The consultancy will begin on 9th April 2018 and end not later than 9th June 2018.

    Consultancy Requirements

    Should hold a relevant Masters in Public Health or Pediatrics, Child health

  • A minimum of 10 years working experience on child health and nutrition programs.
  • Understanding of the Zimbabwe National Health System
  • Proven experience in training, mentorship, supervision and/or monitoring and evaluation of child health and nutrition programs
  • Experience working with the United Nations or other international organizations is preferred
  • Strong writing and presentation skills

    The consultant should have experience/knowledge and expertise on IMNCI, ETAT and IMAM

    If interested and available, please submit your application letter, CV, Technical and an all-inclusive financial proposal detailing monthly professional fees, 5 field travel days outside Harare per month and other miscellaneous expenses

  • UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified candidates from all backgrounds to apply.

    How to apply:

    UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=511878

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